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Gender dysphoria: Reconsidering ethical and iatrogenic factors in clinical practice.

A recent review paper by Halasz and Amos in the journal Australasian Psychiatry, gives a history of the GIDS service at the Tavistock centre from its inception in 1989 to its closure in 2022 and compares “gender-affirming” and “comprehensive care” approaches. The term “gender-affirming care” refers to social, medical and surgical interventions that change the appearance and presentation of the patient to fit more closely with their own perceived “gender identity” (which may be a transient or persisting identification). “Comprehensive care” refers to a primarily mental health approach that seeks to understand the cause(s) of the individual’s gender dysphoria and treat co-existing mental health conditions and trauma.

Using the GIDS closure and the high-profile legal case brought by detransitioner Kiera Bell (who underwent masculinising hormonal treatments she later came to regret), the authors demonstrate that the gender-affirming model used by GIDS was influenced by non-clinical activists with greater understanding of, and interest in, political and social “progress” than individual patient care.

The authors conclude that it is imperative to ensure proper boundaries between clinical units treating gender dysphoria and activist organisations like Mermaids (a charity working with gender-questioning young people but which developed a strong political and ideological presence). They also note that “the certainty associated with gender-affirming care is not backed by any strong evidence of the efficacy/sequelae of the treatment alternatives, particularly over the long term”. 

Halasz G, Amos A. Gender dysphoria: Reconsidering ethical and iatrogenic factors in clinical practice. Australasian Psychiatry. 2023;0(0). doi:10.1177/10398562231211130